Intensive care medicine
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Intensive care medicine · Nov 2007
Automatic detection of ineffective triggering and double triggering during mechanical ventilation.
Imperfect patient-ventilator interaction is common during assisted ventilation, and the detection of clinically relevant mismatching requires visual monitoring of the ventilator screen. We have assessed the feasibility, sensitivity and specificity of an algorithm embedded in a ventilator system that is able to automatically detect the occurrence of ineffective triggering and double triggering in real time. ⋯ We have demonstrated the feasibility and efficacy of a new algorithm to detect the occurrence of impaired patient-ventilator interaction during mechanical ventilation in real time. This software may help the clinician in the identification of this problem, which has been shown to have important clinical consequences.
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Intensive care medicine · Nov 2007
Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses.
To evaluate the outcomes of patients with head and neck cancer and severe acute illnesses, and to identify characteristics associated with hospital mortality. ⋯ In conjunction with clinical judgment and taking into consideration the patient's preferences and values, the knowledge of these outcome predictors may be useful in helping physicians to identify patients who might benefit from the intensive care and to improve discussions on patients' prognosis.
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Intensive care medicine · Nov 2007
ReviewNeuromuscular dysfunction acquired in critical illness: a systematic review.
To determine the prevalence, risk factors, and outcomes of critical illness neuromuscular abnormalities (CINMA). ⋯ The risk of CINMA is nearly 50% in ICU patients with sepsis, multi-organ failure, or protracted mechanical ventilation. The association of CINMA with frequently cited CINMA risk factors (glucocorticoids, neuromuscular blockers) and with short-term survival is uncertain. Available data indicate glycemic control as a potential strategy to decrease CINMA risk.
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Intensive care medicine · Nov 2007
Randomized Controlled TrialChest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours.
This study aimed to determine the impact of providing chest physiotherapy after routine clinical assessment on the duration of mechanical ventilation, outcome and intensive care length of stay. ⋯ Primary endpoints were initial time to become ventilator-free, secondary endpoints included intensive care unit (ICU) and hospital mortality and ICU length of stay. Kaplan-Meier analysis censored for death revealed a significant prolongation of median time to become ventilator-free among patients receiving physiotherapy (p=0.047). The time taken for 50% of patients (median time) to become ventilator-free was 15 and 11 days, respectively, for physiotherapy and control groups. There were no differences between groups in ICU or hospital mortality rates, or length of ICU stay. The number of patients needing re-ventilation for respiratory reasons was similar in both groups.